Treatment by Type of IBD

Treatment for each type of inflammatory bowel disease is similar in idea and practice, but can vary slightly depending on the nature of the condition, the severity of the disease, and the symptoms experienced. Treatment plans often involve systemic steroids, immunomodulating medications (drugs that change or suppress the immune system), biologic medications, and in some cases, surgery. Several common treatment options for each of the main types of IBD are below.

It’s important to remember that response to treatment can be varied from person to person. This means, that although one treatment option may be able to provide an individual with relief from a specific type of IBD, does not mean that the same treatment will have as great of an effect on another individual battling the same condition.

Treatment can often be a trial-and-error process that requires patience and communication between an individual and their healthcare team. It’s important to ask any questions you may have to your doctor or healthcare team about a potential treatment, including its potential side-effects, as well as to report any new or worsening symptoms after beginning a new treatment. This is also the case for individuals who have been utilizing the same treatment for an extended period of time and experience symptom changes.

Crohn’s disease

Common treatment options for Crohn’s disease include the following:

  • Immune system-suppressing medications: These medications include methotrexate, TNF-inhibitors (infliximab, adalimumab, and certolizumab pegol), azathioprine, mercaptopurine, and ustekinumab.
  • Anti-inflammatory medications: oral 5-aminosalicylates (sulfasalazine, mesalamine), and corticosteroids.
  • Antibiotics: To help heal abscesses and fistulas, and reduce drainage. Commonly used antibiotics: ciprofloxacin, metronidazole, rifaximin.
  • Treatment for symptoms, as needed: Depending on the symptoms an individual is experiencing with their Crohn’s it may be beneficial to take specific vitamin or mineral supplements to offset any deficiencies, anti-diarrheal medications to help with severe diarrhea, and specific pain relievers that will not worsen Crohn’s symptoms.
  • Surgery: Approximately 75% of individuals with Crohn’s disease will eventually require surgery. It may become necessary when other treatment options are not providing an individual with relief, or when there is a sudden, severe onset of symptoms. Surgery may also be recommended to help prevent colorectal cancer from developing, as well as to prevent or treat other Crohn’s-related complications including intestinal obstruction, perforation of the colon or bowel, abscess, fistula, toxic megacolon, or excessive bleeding.1,2

Surgery is typically not a curative option for Crohn’s, but is commonly performed for symptom relief. These surgeries generally involve the removal of a portion of the gastrointestinal tract. However, even after surgery, inflammation can return in other areas near the surgical site. The goal of Crohn’s-related surgery is to conserve as much of the gastrointestinal tract as possible, as well as to help improve quality of life. Common surgical procedures include, but are not limited to, strictureplasty, small or large bowel resection, colectomy, and proctocolectomy. Some of these procedures may require the use of a temporary or permanent ostomy bag. With recent medical advances, many of the prodecures can be performed using minimally invasive techniques (laparoscopy), often enabling a faster recovery.2

Ulcerative colitis

Common treatment options for ulcerative colitis include the following:

  • Immune system-suppressing medications: These medications include methotrexate, TNF-inhibitors (infliximab, adalimumab, and golimumab), azathioprine, mercaptopurine, cyclosporine, and vedolizumab.
  • Anti-inflammatory medications: oral 5-aminosalicylates (sulfasalazine, mesalamine, balsalazide, and olsalazine), and corticosteroids.
  • Antibiotics: To help prevent infection. Commonly used antibiotics: ciprofloxacin, metronidazole, rifaximin.
  • Treatment for symptoms, as needed: Depending on the symptoms an individual is experiencing with their ulcerative colitis it may be beneficial to take specific vitamin or mineral supplements to offset any deficiencies, anti-diarrheal medications to help with severe diarrhea, and specific pain relievers that will not worsen ulcerative colitis symptoms.
  • Surgery: Surgery is not as common among individuals with ulcerative colitis as it is with Crohn’s disease, with approximately 23-45% of patients with ulcerative colitis eventually needing surgery. It may become necessary when other treatment options are not providing an individual with relief, or when there is a sudden, severe onset of symptoms or an intestinal perforation. Surgery may also be recommended to help prevent colorectal cancer from developing.1,2

Surgery for those with ulcerative colitis most often involves the removal of the entire colon and rectum (proctocolectomy) and can either be accompanied by an ileal pouch-anal anastomosis (IPAA or j-pouch) or an end ileostomy, which will require the use of an ostomy bag. A j-pouch is the most common surgical procedure performed now for UC, and it does not require an individual to wear an ostomy bag permanently. Removing the entire large intestine will remove the colitis from the body, however, this does not mean the individual is cured or that they no longer have an inflammatory bowel disease as they may still experience symptoms outside of the colon. Specifically, those who have a j-pouch may experience inflammation in the pouch called pouchitis, which is often treated with similar medications as ulcerative colitis.2-4

Indeterminate colitis

The treatment options for indeterminate colitis are similar to other IBDs, and include, but are not limited to:

  • Biologic therapies
  • Corticosteroids
  • Anti-inflammatory medications
  • Immune system-suppressing medications
  • Antibiotics
  • Surgery (in some cases)5,6

It is important to note however, that some of these treatment options, especially certain surgical procedures, are condition-specific. This means that certain treatments or surgical procedures may be beneficial for one type of IBD, and may be detrimental, or risky, for individuals with another type of IBD. For example, if your indeterminate colitis will eventually be diagnosed as Crohn’s disease, but you had a surgical procedure that is beneficial for someone with ulcerative colitis and risky for someone with Crohn’s disease, you may experience complications later on.5 This is why it is important for your healthcare team to thoroughly investigate your indeterminate colitis, to make sure they aren’t able to give a definitive diagnosis before proceeding with treatment.

Microscopic colitis

Treatment of microscopic colitis depends on an individual’s symptoms, past medical conditions, other co-occurring conditions, and current medications taken. Common treatment options for microscopic colitis include:

  • Antidiarrheal medications
  • Anti-inflammatory medications
  • Medications that block bile acids
  • Immune system-suppressing medications
  • Antibiotics
  • Corticosteroids
  • Biologic therapies
  • Changes in diet and nutrition
  • Surgery (in very rare cases)7

The following represent conditions with similar symptoms as IBD and may even include inflammation in the bowels, but they are not classified as an inflammatory bowel disease.

Diversion colitis

Diversion colitis is often rapidly treated by reanastomosis, or the rejoining of the defunctioned bowel to the rest of the intestines.7 However, in some cases this may not be a feasible or beneficial treatment option. In instances where reanastamosis is not possible, there are several other treatment options that can be pursued, and may help improve symptoms. These options include, but are not limited to, enemas containing short chain fatty acids (also called short-chain fatty acid irrigation or short-chain fatty acid topical treatment), and enemas containing corticosteroids.9-11

Behcets disease

Some of the treatment options for Behcet’s are based on the symptoms experienced. For example, some treatment options may include mouth rinses for oral sores, eye drops for eye inflammation, and creams or ointments for skin lesions. Typically, these kinds of treatments will contain corticosteroids or other anti-inflammatory medications. The systemic, or whole body, treatment options for Behcet’s are similar to treatment options for IBD. Some of these treatment options include:

  • Corticosteroids
  • Immunomodulators
  • Anti-inflammatory medications
  • Biologic treatments
  • Surgery (in severe cases that are resistant to other medical interventions)12,13

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